What is EndoVenous Laser Ablation (EVLA/EVLT)?

EVLA stands for Endovenous Laser Ablation. It is often called EVLT, or endovenous Laser Therapy. It is a method of treating the main destroying the cause of varicose veins using laser under local anaesthetic – and has many advantages over the old and out of date stripping method of surgery.

What does EVLA (Endovenous Laser Ablation) mean?

‘Endovenous’ means ‘inside the veins’ – or ‘from inside the vein’ in this case.

‘Laser’ is a sort of energy transmission by light – it actually stands for ‘Light Amplification by the Stimulated Emission of Radiation’.

‘Ablation’ is a term meaning to destroy.

Therefore EVLA means that laser is used to destroy the veins from the inside.

How does it work?

EVLA is performed under local anaesthetic as a ‘Walk-in, walk-out’ technique.

There is no need for a General Anaesthetic – in fact using General Anaesthetic to perform Endovenous Laser Ablation:

adds the risk of an unnecessary general anaesthetic

adds extra cost (for the anaesthetist and general anaesthetic theatre equipment and theatre)

To perform EVLA, the surgeon needs a map of the veins to show which ones are the problem. This map is made using Duplex Ultrasound.

At the EVLA procedure, the surgeon uses ultrasound to find the vein to be treated. The veins that can be treated are the main venous trunks of the legs:

Great Saphenous Vein (GSV)

Small Saphenous Vein (SSV)

Their major tributaries such as the Anterior Accessory Saphenous Veins (AASV)

EVLA does NOT treat the bulging veins on the surface (the varicosities). These are treated after the EVLA by other methods.

Under ultrasound control, a needle is put into the vein near the knee or ankle. A wire is passed into the vein and a long ‘sheath’ is passed up the vein to the top. This ‘sheath’ is a thin tube about the width of a biro refill (for pictures see the EVLA page on www.veins.co.uk).

The ultrasound is used to position the end of the sheath exactly.

Local anaesthetic is injected around the vein – again using ultrasound to make absolutely sure the fluid is in the right place. The local anaesthetic fluid has 3 uses:

Local anaesthetic numbs the vein and the surrounding tissue

Adrenaline in the mixture causes the vein to contract onto the laser sheath giving good contact

The volume of fluid disperses the laser energy – making sure the tissues around the vein are not harmed when the vein is destroyed by heat

This technique is called ‘Tumesence’ or ‘Tumescent anaesthesia’.

Once the anaesthetic is in place, the laser fibre is passed up inside the sheath until it comes out of the top. The fibre is fixed to the sheath and the laser is switched on.

The sheath and laser are then pulled back at an exact rate, making sure the vein is completely destroyed – but without damaging the surrounding tissues.

There are variations to the technique above, but research from The Whiteley Clinic and elsewhere has shown this technique to be safe and reproducible.

Why use EVLA?

Varicose veins are often thought to be the lumpy veins that people see on their legs. Although these veins can be seen in some people with vein problems, these visible varicose veins are not the real problem. They are just a sign of the underlying major problem – venous reflux or ‘vein pump failure’.

So to treat varicose veins and the other vein problems successfully (such as phlebitis, venous eczema, lipodermatosclerosis, venous leg ulceration and even many people with thread veins of the legs), the underlying main veins that aren’t working, which means they let the blood fall the wrong way down the leg causing the damage, need to be fixed by reversing the blood flow.

Unfortunately, when the valves stop working in these main veins, the the valves cannot be fixed. Therefore, to stop the blood from flowing the wrong way down the veins and causing damage, we need to close the veins completely.

Over the last 100 years, surgeons have operated on patients with varicose veins and venous diseases by tying the veins closed and then stripping them out. However, prize winning research by us, at The Whiteley Clinic, has shown that this barbaric operation doesn’t even work in a large number of patients – as the veins grow back!

However, we have also shown that if the same veins are destroyed by heat – for example by using EVLA – the veins are closed in a way that makes them shrivel away and never grow back again.

What is the difference between EVLA and EVLT™?

When something works, lots of companies produce similar products to “get in on the act”.

Originally the technique was invented following a discussion by 3 doctors at a venous meeting in 1998:

There had already been some success shown by using heat to destroy the venous trunks using radiofrequency (VNUS Closure®) and so these doctors started using laser to do the same.

Initially they used a laser called a diode laser, that produced laser “light” at a wavelength of 810 nm. This was highly efficient in destroying the vein wall, but caused quite a lot of bruising in some people. The 810 nm diode laser was patented and called it EVLT® – EndoVenous Laser Treatment or EndoVenous Laser Therapy. This technique was originally picked up and sold by a company called Diomed.

Other companies saw the potential and started producing equipment and lasers to destroy varicose veins the same way. As EVLT® is a registered trademark, they had to think of other names to call their products. Many of them had different sorts of sheaths or equipment – others used different laser wavelengths.

There are now many different forms of EndoVenous Laser – ie: 810 nm, 940 nm, 941 nm, 1064 nm, 1320 nm and other wavelengths – different sized sheaths, end-firing lasers fibres and side-firing laser fibres etc. However ALL of them are forms of EVLA – as they all ablate veins from within using laser.